Clinical Outcomes after Spinal Cord Stimulation According to Pain Characteristics

Objective@#: Spinal cord stimulation (SCS) is an effective treatment for chronic neuropathic pain. However, its clinical efficacy in regard to specific types of pain has not been well studied. The primary objective of this study was to retrospectively analyze the clinical outcomes of paddle-type SCS according to the type of neuropathic pain. @*Methods@#: Seventeen patients who underwent paddle-lead SCS at our hospital were examined. Clinical outcomes were evaluated pre- and postoperatively (3 months, 1 year, and last follow-up) using the Neuropathic Pain Symptom Inventory (NPSI). The NPSI categorizes pain as superficial, deep, paroxysmal, evoked, or dysesthesia and assess the duration of the pain (pain time score). Changes in NPSI scores were compared with change in Visual analogue scale (VAS) scores. @*Results@#: After SCS, the pain time score improved by 45% (independent t-test, p=0.0002) and the deep pain score improved by 58% (independent t-test, p=0.001). Improvements in the pain time score significantly correlated with improvements in the VAS score (r=0.667, p=0.003, Spearman correlation). Additionally, the morphine milligram equivalent value was markedly lower after vs. before surgery (~49 mg, pared t-test, p=0.002). No preoperative value was associated with clinical outcome. @*Conclusion@#: The NPSI is a useful tool for evaluating the therapeutic effects of SCS. Chronic use of a paddle-type spinal cord stimulation improved the deep pain and the pain time scores.

Presyrinx Associated with Post-Traumatic Hydrocephalus Successfully Treated by Ventriculoperitoneal Shunt / 대한신경손상학회지

Presyrinx consists of reversible spinal cord swelling without frank cavitation, as observed on T2 weighted magnetic resonance imaging (MRI). The condition may evolve into syringomyelia, but timely surgical interventions have achieved meaningful results. Here, we report the case of a 27-year-old woman who presented with headache, dizziness, and diplopia 2 months after suffering a mild head trauma. On MRI, hydrocephalus, downward herniation of the cerebellar tonsil, and a diffuse high signal change in the cervical spinal cord were detected. After insertion of a ventriculoperitoneal shunt, her neurological symptoms resolved, and she has had no signs of presyrinx recurrence for >4 years.

Expanding Subdural Hematomas in the Subacute Stage and Treatment via Catheter Drainage / 대한신경손상학회지

OBJECTIVE: Rapid expansion of subacute subdural hematomas (saSDHs) is an uncommon complication in the course of acute subdural hematomas (SDHs). The current study evaluated relevant factors and treatment methods for saSDHs with neurologic deterioration and mass effect. METHODS: A saSDHs was chronologically defined as an SDH occurring 4 to 21 days after head trauma. All cases of surgically treated SDHs were retrieved from the head trauma bank at our institution. Twenty-three patients with expanding saSDHs who met the following criteria were enrolled in the study: defined age of the hematoma, clinical deterioration, and radiological expansion of the hematoma. Cases were analyzed according to demographic factors, trauma mechanism, medical co-morbidity, and surgical method. RESULTS: Expanding saSDHs occurred more often in older (≥60 years old) than in younger patients (69.6% vs. 30.4%, respectively); they also occurred more often in men than in women (64% vs. 36%, respectively). Antiplatelet or anticoagulant therapy was used in 52% of patients. The Glasgow Coma Scale score was 13 at the time of the trauma and deteriorated to 11 at the time of surgery. The mean time from the trauma to development of the expanding saSDH from an SDH was 13.3 days. Regarding surgical methods, closed-system drainage was performed in 22 patients, and only one patient underwent craniotomy with hematoma removal. All patients exhibited neurological improvements after surgery. CONCLUSION: An expanding saSDH usually occurs around 13 days after trauma in older adults. Minimal trephination with closed-system drainage can be used to manage an expanding saSDHs.